DE60014650T2 - Novel knee protection - Google Patents

Novel knee protection

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Publication number
DE60014650T2
DE60014650T2 DE60014650T DE60014650T DE60014650T2 DE 60014650 T2 DE60014650 T2 DE 60014650T2 DE 60014650 T DE60014650 T DE 60014650T DE 60014650 T DE60014650 T DE 60014650T DE 60014650 T2 DE60014650 T2 DE 60014650T2
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DE
Germany
Prior art keywords
insert
femoral part
curve
part
femoral
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Active
Application number
DE60014650T
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German (de)
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DE60014650D1 (en
Inventor
Michel Bercovy
Original Assignee
Michel Bercovy
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Publication date
Priority to FR9909664 priority Critical
Priority to FR9909664A priority patent/FR2796836B1/en
Application filed by Michel Bercovy filed Critical Michel Bercovy
Priority to PCT/FR2000/002133 priority patent/WO2001006961A1/en
Publication of DE60014650D1 publication Critical patent/DE60014650D1/en
Application granted granted Critical
Publication of DE60014650T2 publication Critical patent/DE60014650T2/en
Application status is Active legal-status Critical
Anticipated expiration legal-status Critical

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/38Joints for elbows or knees
    • A61F2/3868Joints for elbows or knees with sliding tibial bearing
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/38Joints for elbows or knees
    • A61F2/3859Femoral components
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/38Joints for elbows or knees
    • A61F2/389Tibial components
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30329Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30331Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
    • A61F2002/30332Conically- or frustoconically-shaped protrusion and recess
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30329Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30331Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
    • A61F2002/30362Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit with possibility of relative movement between the protrusion and the recess
    • A61F2002/30364Rotation about the common longitudinal axis
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30329Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30518Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements with possibility of relative movement between the prosthetic parts
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/30767Special external or bone-contacting surfaces, e.g. coating for improving bone ingrowth
    • A61F2/30771Special external or bone-contacting surfaces, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30878Special external or bone-contacting surfaces, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/3094Designing or manufacturing processes
    • A61F2/30942Designing or manufacturing processes for designing or making customized prostheses, e.g. using templates, CT or NMR scans, finite-element analysis or CAD-CAM techniques
    • A61F2002/30943Designing or manufacturing processes for designing or making customized prostheses, e.g. using templates, CT or NMR scans, finite-element analysis or CAD-CAM techniques using mathematical models
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2220/00Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2220/00Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0033Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2310/00Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00005The prosthesis being constructed from a particular material
    • A61F2310/00011Metals or alloys

Description

  • The The present invention relates to a new prosthesis for a knee joint. This prosthesis has the particular aim of providing a device the funds for optimal contact, stabilization and guidance between the moving parts in the course of the three-dimensional movements contains.
  • you remembers that a knee prosthesis is an implant that is used for surgical replacement of a damaged knee joint.
  • A knee prosthesis includes bone-related elements, which are generally metallic, and sliding elements generally made of a plastic material such as polyethylene. The metallic elements are:
    • A femoral part that approximately reproduces the shape of the femoral joint of the knee; it is connected to the bone, either directly over a rehabitable surface, indirectly through the detour of an acrylic resin;
    • - a tibial surface, which is connected to the upper end of the tibia (tibia), be it directly, be it by means of an acrylic resin; and
    • - A rotula surface, which is connected to the posterior surface of the Rotulaknochens, be it directly, be it by means of an acrylic resin.
  • These Metal parts are generally made of chromium-cobalt, titanium or Stainless steel or other metals and alloys, in particular ceramic.
  • The Parts for gliding and steaming, which separate the metallic parts are generally made polyethylene; you can either connected to the tibial part or the fixed plateau or with respect to the latter being movable with a variable one Degree of mobility in rotation (horizontal plane), in the Anterior-posterior displacement (sagittal plane) and medial-lateral displacement (Frontal plane); be they fixed or mobile, the sliding parts called "inserts" made of polyethylene are articulated with the femoral part over two Femoralgelenkköpfe connected, the inner and the outer, the a certain congruence with the respective two concave surfaces of the Polyethylene insert, called the acetabular depressions become. A prosthesis is called "with movable plateau ", when the insert has free axial rotation. The prosthesis according to the invention is preferably of this type.
  • The free axial rotation is a logical consequence of congruence, the Congruence is a bigger tribological one Advantage, thanks to which the pressures and the wear of the polyethylene forming the insert low are what a longer one Lifespan of the prosthesis brings with it.
  • In the most recent forms of prosthesis, the support is performed over three surfaces with a third support zone located between the two condylar heads in contact with a median projection located on the upper surface of the insert. The interlocking of these two sections can mean:
    • Either a third femoral condyle in a third cavity of the upper surface of the insert,
    • - or an elevation in the upper surface of the insert in a cavity (housing) located between the two femoral joint heads;
    • - or different shapes of cams, which sit between the femoral articular heads and rest on a ridge on the upper portion of the insert.
  • In all cases Of course, there are angles in a plane of the cut surface, which makes the contact between the parts discontinuous.
  • Of the Anterior section of the femoral prosthesis (trochlea) pivots by means of a medallion made of polyethylene with the rotula. This medallion made of polyethlyene is connected to the rotula base, or it may be related to to be mobile on this latter. There is a certain congruence between the femoral joint and the curl joint.
  • A Knee prosthesis does not have the exact shapes of an anatomical joint play. In fact, in the latter represent the Menisci the congruence between the femoral and tibial parts. The cruciate ligaments and the lateral ligaments Keep these parts together and put in cooperation with the asymmetric shape of the joint surfaces in a relative motion the three levels of space (frontal, sagittal and horizontal) safely. Because these different anatomical elements in the knee prosthesis are absent, the latter has three types of requirements suffice: the physiological requirements, the tribological requirements and the requirements of stability.
  • (1) Physiological requirements
  • The physiological requirements of the knee must be respected and, in particular, the respective movements and positions of the femur with respect to the tibia: rolling / sliding with the return of the point of contact of the femur on the insert during flexion (90 °) and advancement of the femur during extension ( 0 °), which determines the moment of action of the rotulase tendon, which controls the effectiveness of the muscle drive and, via this detour, the comfort of the patient, the quality of the walking, ascending and descending stairs, rising from a low position. These references must be ensured in the course of the movements by the shape of the articular surfaces of the prosthesis parts (determined by the design of the prosthesis) and in particular by a cam effect between the femur and the insert in cooperation with a balanced tension of the lateral ligaments of the knee joint, determined by the act of the surgeon and by an auxiliary instrumentation that respects this requirement.
  • (2) Tribological requirements
  • The tribological requirements be respected, so that the contact between the metallic Femoral parts and the tibial and rotula inserts made of polyethylene none Producers of phenomena of deterioration of polyethylene are. Especially have to the contacts as congruent as possible be because selective, linear or weak-area contacts producers of a increased Pressure in the polyethylene and thus of wear and creep of the the latter are.
  • In certain forms of prostheses, the polyethylene insert is fixed with respect to the tibia. In this case, the tangential movements of rolling / sliding, shearing, and all rotational movements in the contact zone between the femoral joint heads and the tibial joint pans are discontinued. Since the contacts are weak, increased pressures can be achieved at the level of the polyethylene. The designers' recommendations generally advise to respect a pressure less than or equal to 10 MPa in the zones of polyethylene where the overlay is constant, ie in the zones near the walking position. An ideal pressure of 4 MPa is desired. In the prostheses with a weak congruence (linear or puncture joint surfaces between the femur and the polyethylene insert), however, pressures above 30 MPa are often measured, which can even reach 50 MPa. This leads to a rapid degradation of the polyethylene, which may require further interventions to replace the prosthetic implants. A contact surface of more than 400 mm 2 is recommended. The prior art has resulted in the field of prosthetic joints to produce prostheses, the inserts of polyethylene are congruent with respect to the femoral surface, this congruence has the logical consequence that the insert with respect to the tibial base in the rotation must be movable , These implants are called moveable plate prostheses. In these cases, joint congruence can be respected, allowing for increased surface area contacts. With this type of prosthesis, pressures of the order of 4 to 8 MPa in the polyethylene are often obtained, which favors the life of the latter.
  • There are several congruent prostheses, but all have two major disadvantages that the present invention seeks to correct:
    • - The contact congruence between the condylar and the tibial articular pans exists mainly near the extension, but decreases in the course of the diffraction;
    • - congruence is planned only in a single plane: the sagittal plane; Thus, increased stresses may occur in the contact zones upon movements of tilting or rolling, turning, or a combination of these three directions, especially if the surfaces have angles.
  • Around to remedy this the different surfaces tangential to each other in the two spatial planes (sagittal and frontal) be to glide without sudden stops and without corner contacts in to enable the three directions.
  • (3) The stability requirements
  • Respect for the stability of the knee bearing a prosthesis can be achieved through various mechanisms:
    • - Preserve the two cruciate ligaments;
    • - preservation of only the posterior cruciate ligament, but it has been shown that in this case the anterior-posterior movement does not take into account satisfactory kinematics;
    • Finally, stabilization of the prosthesis by a central mechanism designed to guide the femur with respect to the tibia.
  • The last type of mechanism is actually the most effective to the stability in accordance with the kinematics of the knee, and there is a device of this type, which relates to the present invention.
  • The state of the art in this area suggests several types of mechanisms:
    • The most classical is that of a pole that comes into contact with a vertical central block of variable shape;
    • Other mechanisms rely on a cam cooperating with a central stop having a profile complementary to this cam, eg the third central femoral head located between the two lateral rod ends;
    • - In other prosthesis assemblies may be a third central condyle, which is itself in the form of a transverse cylinder, which engages in the form of a cam in a transverse cylinder which terminates in its anterior portion.
  • This latter construction has, as a detrimental effect, the complete absence of the anterior post freedom of movement between the femoral part and the tibial insert when the cylinder has the same transverse axis as the two lateral rod ends. It is thus a mechanism of the so-called hinge type, which may be responsible for increased pressures at the level of the joint between the rotula and the femur. The mechanism of rolling / sliding is not respected, and one of the consequences may be the presence of severe rotula pain. The recovery of a certain mobility front / rear in the contact zone between the polyethylene insert and the tibial plate is not sufficient to compensate for this disadvantage; this mobility, which is at a different level from the normal level, produces a parasitic, "roll-forward" movement, during which the tibia recedes on flexion with respect to the femur, which can cause dislocation of the prosthesis parts.
  • In a structure of this type of prosthesis (see WO 98/46171 A) contains the central projection on its upper surface a leading one Curve on a complementary area rests, which lies between the two rod ends, creating a cam effect which is optimal movement of the femur with respect to the tibia developed. The intervention of this device in the frontal plane However, it returns a broken curve, the source of bumps, of Corner contacts ("edge-contact"), from hard stops, and therefore, by mechanisms involving a relaxation of the prosthesis can bring.
  • The The present invention is therefore based on a movable prosthesis Plateau, with the plateau or the insert in the transverse Direction on its upper surface with the articular surfaces of the femur and with its lower surface with the upper surface of the metallic base implanted into the tibia is completely congruent.
  • Under show the currently existing prostheses with movable plateau most of the congruence in the zones close to the stretch, but this congruence diminishes considerably during the Diffraction due to the progressive reduction of the radii of the Condyle curve in the posterior portion of the joint, while the Curve radius of the tibial plate remains constant. That is due to the polycentric radius of the condyle in the sagittal plane.
  • Other Implants have contact surfaces that are increased from the extension to the diffraction. In these versions However, the different sagittal planes (in the plane XY) are against each other moved, resulting in a broken front view Line expresses the one for that susceptible is, increased To generate load peaks at the level of polyethylene as well as transmissions of abnormally high loads, shocks, and vibrations on the Attachment points of the prosthesis during the movements of rolling / lateral tilting.
  • in the Generally, the circulation of the knee prostheses happens through the contact between the femoral joint heads and the tibial articular pans with a medial overlay and a lateral support. Because the mechanical axis of the body, the from the center of gravity of the body to the contact of the foot goes to the ground, with respect to the knee joint runs in a medial manner, are the pads on the two areas of the knee (medial and lateral) asymmetric, which creates multiple sources of problems:
  • A of it is the fact that created a moment of relaxation is caused by a pressure in the internal area, which is significantly higher than a pressure in the outer area. Therefore, the outer area has The knee has a tendency to reach the level of its tibial attachment to lift and a possibility the replacement of the latter, which is a source of mobilization Denture is what causes deterioration and a new surgical Act lead can.
  • A other source of problems lies in the fact that between the support phase and the vibratory phase is a step of detaching the metallic femoral part with regard to the use of polyethylene, which is called in English "lift-off" and the man in French translate with "roulis" effect can. This "lift-off" occurs mainly between 40 and 70 ° knee flexion on, especially in the range 50 to 70 °. It is generally about a detachment of the lateral condyle with respect to the lateral tibial plate. This "lift-off" physiological on Way (about 1.8 mm) may exist, in certain cases of prostheses amplitudes reach of several millimeters, even 5 mm or more.
  • In that according to the invention elaborated form of circulation happens the circulation by the detour of the concave-convex meshing in the frontal and sagittal plane through the lateral rod ends on the central tip as well as on the lateral oblique sides this dome, what, how later will see one of the major orginalities of the present invention is.
  • In the concept proposed according to the invention, the resultant of the transmissions of the loads preferably occurs in the middle portion of the tibial base around its central cone-shaped fastener inserted in the middle of the upper end of the tibial bone. This kind of transfer has The aim is to maximally reduce the effect of the mediallateral moment which is responsible for the relaxation or also for the predominant wear on one of the two areas.
  • Of the concave-convex engagement in the frontal and sagittal plane between the central depression of the femur and the torus (the middle Increase of Insert) offers the advantage in the course of the lift-off movement and independent from the flexion angle of the knee a congruent and progressive Edition to offer.
  • These Form of contact between the metallic femoral part and the Polyethylene insert allows it also the contacts in a continuous manner through progressive intervention the contact surface to change let while avoiding shocks and Vibrations, which, when attached to the anchorages of metal parts in which tibial or femoral bone are transmitted, source of There are vibrations that continue there loosening of the prosthesis parts favor, which leads to a replacement of the latter.
  • The present invention aims to propose a knee prosthesis which does not have the above-mentioned disadvantages of the prior art prosthesis. The prosthesis according to the invention has two aims:
    • The congruence designed to protect the longevity of the polyethylene used and to reduce wear;
    • - A kinematics, which is intended to give the patient a comfortable functioning.
  • THE CONGRUCTION
    • - One Congruence with a big one Contact area between the femoral part and the insert regardless of the diffraction angle allows it to reduce the pressures exerted on the polyethylene;
    • - The Congruence must decrease in the course of diffraction, with the large contact area in the support area from 0 to 60 ° required but the bending range beyond 90 ° does not require a large contact area, because: - the Use of this area is very rare; - the up all diffraction angles, in particular extended beyond 90 ° Congruence a very limited Prosthesis and therefore a risk of excessive loading of the anchorage; - the congruence the heightened surface independently from the diffraction angle is required, but without corner contact and without flattening zone or direction reversal of pin and hole type, the while engage the movements of the lift-off or lateral inclination: that is the frontal congruence.
  • THE KINEMATICS
    • - The Kinematics must favor the lever arm of the stretching device (Work efficiency of the quadriceps muscle by means of the rotula and the Rotula tendon) to be an effective force during the To ascend and descend stairs. This is due to an anterior shift of the rotula support the trochlea achieved in the stretching.
    • - The kinematics must respect the real rolling / sliding of the knee. This is defined in the following way: the contact point of the femoral part with respect to the insert, when stretched at 0 °, is a few millimeters before the center of this insert, and it retreats a few millimeters behind the center of the insert, when the diffraction 15 to 20 ° without the femoral part and the femoral bone segment moving backward with respect to the tibial part or the tibial bone segment. This differs from the false rolling / gliding, in which the femoral part and the femoral bone retreat by a cam effect with respect to the tibial part of the prosthesis or tibial bone, a phenomenon which must be avoided because it is a producer: 1. Increase from abnormally Pressing on the polyethylene of the rotula and the insert, source of premature wear and pain; 2. translational movements of the femur from front to back on the insert, causing delamination below the surface of the polyethylene and thus premature wear of the latter.
  • To address these goals, the present invention proposes a new geometry of the surfaces of the femoral part and insert. More particularly, the invention relates to a knee joint prosthesis which includes:
    • A system with three support zones between the femoral part and the insert;
    • A system with a continuity of contact between the bearing surfaces of the femoral part and the insertion mediallateral;
    • A concave-convex succession of surface segments;
    • In the frontal plane, a succession of engagement femoral component insert concavo-convex, then convex-concave, then concave-convex, starting from the medial section to the lateral section;
    • In the sagittal plane, the three femoral surfaces (medial, central and lateral) have a convexity directed downwards, while the three surfaces of the insert have an upward concavity so that one has a central zone in the form of a saddle, but a continuous mediallateral contact.
  • The Invention has alike to propose a knee prosthesis in which the general Form of the three zones (lateral, central and medial) of the femoral part is determined by a spiral curve in the sagittal plane, wherein the general shape of the three zones (lateral, central and medial) of use alike is determined by a spiral curve in the sagittal plane, where the generating spiral curve of the insert from the generating spiral curve derived from the femoral part. These two spiral curves will be calculated with the aim of real rolling / gliding according to the above To reproduce definition.
  • The Invention has alike to the goal a knee prosthesis, in which the congruence of the articular surfaces between the femoral part and the deployment at the frontal level is due to a succession of continuous curved surfaces on the Level of the three support zones, with the curved surfaces are interconnected without any discontinuity or sharp edge or direction reversal line or flattening, causing thus a movement in rolling in translation and in inclination in the frontal plane between the femoral part and the insert is made possible in the course of which the contact area independently from the diffraction angle is always congruent. In the sense of the present Invention is believed that the surface of the prosthesis is a flattening when, in one of its points, the surface of the prosthesis is more than one millimeter at least three tangents to this surface, which define a plane.
  • The Invention finally has To the goal of a knee prosthesis, in which the pads in a continuous manner transferred from the medial part to the lateral part of the prosthesis be in the course of the cycle of walking with a bum-free Stress without risk of vibration or sudden transmission of stress, which for the patient has an effect of pleasant suppleness is avoided and that he feels shocks.
  • To this end, the object of the invention is a knee prosthesis of the type comprising a generally metallic femoral part suitable for implantation in a femur, a generally metallic tibial part suitable for implantation in a tibia, and Includes intermediate part or insert of a plastic material such as polyethylene, which is inserted between the femoral part and the tibial part, wherein the insert can be fixedly connected to the tibial part or rotatable about a vertical axis relative to this movable, the femoral part on the one hand contains two Seitenab sections, the be adapted to rest and move in two lateral recesses of the corresponding profile of the insert and, on the other hand, a recessed central portion which is arranged between the side portions and adapted to take on a projecting central part of the insert receiving the projecting middle section the femoral part facing surface of the insert from the front to the back of the insert seen from the front has a convex shape and seen in profile a concave shape, while the central portion of the femoral part from its front to its back seen from the front of a concave shape and Seen in profile has a convex shape, which allows him to ride in the course of its relative movements on the projecting portion of the insert and cooperate with him in the manner of a cam, said prosthesis being characterized in that
    • The surfaces of the femoral part and the insert, which are called to come into contact in the course of the relative movements of the two parts, have no discontinuity or edge and by overlapping of concave portions and convex portions in the course of their movements in each of the sagittal - and frontal levels to cooperate;
    • - The surface of the insert, which faces the corresponding surface of the femoral part, in a section in a frontal plane is a curve having a wavy center portion in the form of a saddle, the convexity of which faces the femoral part and on each side to a recess portion and having a shape substantially corresponding to that of the associated portion of the femoral part, the whole forming a wave curve without discontinuity or edge of the general type of sinusoid so that in section in a frontal plane the surface of the femoral part corresponding to the corresponding surface of the femoral part Turning the insert faces and medial-lateral is in continuous contact with the latter, is a curve having a corrugated central portion, whose concavity faces the insert and which connects on each side to side portions of the femoral part, the whole a wave curve without discount inuity or sharp edge of the general type of sinusoid.
  • In this prosthesis, the femoral surface is formed starting from a spiral curve in the sagittal plane passing through a wave pattern of sine wave in the frontal plane, and the surface of the insert is formed from a spiral curve in the sagittal plane which is a sinusoidal wave curve in FIG the frontal plane passes through, with the two surfaces in each of the two levels form a concave-convex engagement.
  • The surfaces of the femoral part and the insert which are called to come into contact with each other in the course of the relative movements of the two parts are thus portions of the surface which have no discontinuity, edge, flattening or zone of reversal of direction and which overlap the concave ones Sections and the convex portions interact independently of the diffraction angle in the course of the totality of movements in both the sagittal and in the frontal plane. The surfaces of the femoral part and insert, which are arranged in relation to each other, are intended to allow the movements:
    • In a frontal plane: a so-called "lift-off" movement, ie the sliding lifting and angling of one of the side portions of the femoral part, whereby a contact between the femoral part and the insert remains congruent both in the lateral depression of the insert and independent of the diffraction angle on the whole or a portion of the central projection of the latter;
    • In a sagittal plane: a diffraction movement preferably with a real rolling / sliding of the femoral part on the insert, ie a shift of the contact point of the femoral part on the use of a few millimeters before the center of the insert in the extended position 0 to a few millimeters behind the middle the insert in the flexed position, but without displacement of the femoral part itself or the bone segment that it carries with respect to the tibial part (absence of translation);
    • In a horizontal plane: rotation with respect to a vertical axis whose amplitude varies, according to whether the insert is movable in rotation with respect to the tibial part or not; According to the invention, the insert is preferably free in the axial rotation.
  • More accurate contains said the surface of the insert facing the corresponding surface of the femoral part is and in the medial-lateral direction (transversal) in continuous Contact with the latter stands, in sectional view in a frontal plane two lateral curve sections with an upward concavity and a middle curve portion whose convexity to the Femoral part is directed, with the convexity of the middle section on each side connects to the concave sections with a profile that essentially the corresponding lateral portion of the femoral part corresponds, with the whole from the front to the back Using a curve without discontinuity or edge or flattening forms, which resembles a sine wave.
  • As well has the femoral part from the front to the back its side sections into a sectional view in a frontal plane a complementary one Profile on. In other words is there a medial convex curve that is directed downwards, then a central concavity, which overlaps the central portion of the insert, then a lateral convexity that follows is directed downward, these three curve segments in the medial-lateral direction (transversal) in continuous contact with the corresponding surfaces of the Use stand.
  • A Prosthesis of the former Technique (see U.S. Patent No. 4,470,158) also contains a femoral part, which is formed by two generating curves, a frontal curve, which goes through a sagittal curve. This earlier However, prosthesis differs fundamentally from that of the application in that that the frontal generation curve is a geometric element of the Design is, but not at all a contact zone between the prosthesis parts (femur and insert) equivalent. In fact, the femoral part of this prosthesis only has the two classic rod ends separated by a discontinuous zone (an incision) are, while according to the present Invention a total continuity from one side of the femoral part to the other.
  • In in this US patent is the section of the production curve called K3 an element of the design, but not a zone of a continuous one Matter and an edition of the femoral part on the insert as in the prosthesis according to the invention. The frontal production cowl of the US prosthesis passes through a polycentric sagittal curve, the four segments with different Contains radii from front to back, while according to the present invention the frontal curve passes through a spiral generating curve.
  • In another prior art prosthesis (U.S. Patent No. 5,609,639 to Walker), a femoral part has continuity in the portion located between the two "condylar heads" and comes into contact with a "meniscal" component that has a central one curved portion, the convexity of which faces the femoral part and is connected to two lateral recessed portions. However, it is shown that the femoral portion has a constant radius in the sagittal plane and that the "meniscal" component either has a constant sagittal radius, with front to back mobility occurring between the meniscal component and the tibial plane, or a variable sagittal radius defined by the impression of movements from the front to the back, impressed by the femoral part on the constant sagittal radius. This can neither the forms nor any of the functions the movement or contact that is possible by the intervention of a spiral in a spiral.
  • In the frontal plane, the femoral part of the Walker patent has a "condyle" (and hence anatomical) shape and conformance to the lateral depressions of the meniscal component (also anatomical), which distinguishes it from the present invention. In this patent, no geometrical description is given of the contacts in the middle section between the femoral part and the "meniscus" component except through continuity of the contact. When you look up 3 (b) and 3 (c) According to this patent, it is noted that in the posterior portion of the insert there is a flattened center zone which adjoins the side sections via angled edges, which is incompatible with the properties of the surfaces of the femoral part and the insert according to the present invention, and with Figs kinematic and tribological benefits that follow. Likewise, the trochlea of the femoral part is the 3 (b) flattened and contains in its central portion no concave-convex shape. It must therefore connect with angles to other surfaces.
  • Finally describes still according to the earlier technique Patent FR No. 2,621,243 a prosthesis whose tibial part in his Middle section has a shape of a horse saddle, wherein the Femoral part only about a punctual contact with the Tibialteil comes into contact and only on the middle section, without any contact between the side sections of the Femur and the tibial element gives. Also, the shape of the tibial saddle in the sagittal plane simply convex and will not go through a curve defined by the type of a spiral. So it does not have the benefits the with the intervention of a spiral into a spiral during the diffraction of the knee is connected about a transverse axis.
  • In The practice is in the prosthesis according to the present invention the exact shape for the Spiral curves of the insert and the central surface of the femoral part in the Sagittal plane is assumed, starting from radiographs of the knee of the patient defined in different diffraction positions, so that as accurate as possible the shift of the contact point of the natural joint in the real one Rolling / sliding is reproduced, i. a shift of the contact point without displacement of the bone segments or prosthetic components.
  • As well will be the exact shape for the curve in the frontal plane should be assumed by the Necessity of tilting about 5 ° between the femoral part and the use defined in the "lift-off" lateral Take off (or varos-valgus).
  • The distinguishes the prosthesis according to the invention from that of WO 98/46171 A, in which, even if a continuity with three Support surfaces exists (two rod ends and a cam between the rod ends), the conformity in the Frontal plane only the lateral recesses of the insert and the corresponding "rod ends", but not the middle section.
  • The attached Schematic drawings illustrate in more detail an embodiment the invention. Of course you have no restrictive Properties. In these drawings:
  • is 1 an exploded perspective view of a knee prosthesis according to the invention;
  • is 2 a schematic view on a larger scale, showing the substantially complementary shape of the contact surfaces with respect to the insert and the femoral part; and
  • shows 3 Sections of the contact surfaces with respect to the insert and the femoral part in a frontal plane.
  • By 1 shown knee prosthesis contains a generally metallic femoral part 1 , which is suitable for implantation in the femur of the patient, also a metallic tibial part 2 , which is suitable for implantation in the tibia of the patient, and an insert 3 which is generally made of a plastic material such as polyethylene.
  • The use 3 lies on a plateau 4 of the tibial part 2 and, as shown in the design, may be rotatably movable with respect to the platform about an axis that is vertically disposed in the position of use of the prosthesis. For this purpose, the insert contains 3 projecting from his part here 2 facing surface of a survey 5 , in a known manner in a central hollow cone 6 of the tibial part 2 intervenes.
  • In the usual way, the femoral part contains 1 two side sections whose cross-section, in section in a sagittal plane, is in the form of a coil whose exact mathematical equation is foreign to the present invention.
  • The femoral part 1 is intended to be preferably in accordance with a rolling / sliding movement of the side portions 7 on recessed sections 8th the part 1 facing surface of Einsat zes 3 to move, which have substantially corresponding shapes, also with a profile of a turn, seen in section in a sagittal plane.
  • According to the invention, the use 3 in its middle section a projecting spine section 9 on, which forms a cam, seen from the front (s. 2 and 3 ) has a corrugated profile, the convexity of which faces the femoral part, while having a concave profile in the form of a saddle, seen from the side, this projecting portion 9 has no discontinuity, angle, or edge and tangential in all directions also without discontinuity, angle or edge to adjacent surfaces 8th followed. The section 10 of the femoral part 1 has a substantially complementary shape to that of the section 9 the insert, which it superimposes from the extension to the full inflection, and also closes tangentially in all directions without discontinuity, angle, flattening or edge to the side sections 7 at.
  • This riding the femoral part on the insert 3 thus represents a concave-convex engagement of the two parts in a sagittal plane and a concave-convex engagement of the second plane in a frontal plane, which, of course, anterior-posterior-translation of the femoral part 1 in terms of use 3 allows the guidance is made by engaging the projecting portion 9 of the insert, the upper surface of which is concave in section in a sagittal plane, into the cusp between the condylar heads of the femoral part 1 whose median lower surface is convex in a sagittal plane, this procedure taking place throughout the movement-flexion extension.
  • This median concavo-convex intervention allows the same Stopping abnormal movements (subluxation or dislocation) to the front or to the back of the femur with respect to the tibia or vice versa with the advantage a progressiveness this stopping because of the continuity of the surfaces in the mutual contact.
  • The exact shape of the cam forming projecting portion 9 in the sagittal plane is determined by going to radiographs of the knee joint, which is angled in large numbers of different positions, and it is not defined by an exact mathematical equation. This cam is such that at a diffraction angle of 0 °, the femoral part support center on the insert is a few millimeters before the center of the insert, and from a certain diffraction degree, which is between 15 and 20 °, a few millimeters behind this center ,
  • The different surfaces each of the femoral part and the insert are easy in all levels tangent to each other without any breaking zone, with the contact area from the front to the back of the mission, as physiology wants.
  • 2 Figure 4 shows the surfaces created for the femoral part contact surface by the two curves S1 and Spi F and the contact surface of the insert of S2 and Spi T.
  • As stated above, the curves Spi F and Spi T have the form of a spiral, without this term implying an exact mathematical definition. Likewise, in a section in a frontal plane, the contact surface S1 of the femoral part 1 and the contact surface S2 of the insert (s. 3 ) a sinusoidal profile without this term implying a precise mathematical equation.
  • It should be noted that the recessed middle section 10 of the femoral part 1 from front to back over a curve with constant radius R 2 to the side sections 7 this part 1 can connect. Likewise, the femoral part can 1 facing convex middle section 9 of the insert 3 from front to back over a curve of constant radius R ' 2 to the lateral recessed portions 8th connect this insert.
  • The prosthesis according to the invention has the advantage of increasing the physiological kinematics of the knee respect, i. the preferred movement of rolling / sliding of the joint with the retreat the point of contact of the femoral part on the insertion of the extension to the diffraction, what the action moment of the drive device optimized and therefore the propulsive force of the knee at an increase, a dismount and getting up.
  • It has the same advantage:
    • To maintain an increased contact surface in the course of the flexion of the knee, which as a consequence causes a low pressure in the polyethylene and therefore a weak wear of the prosthesis;
    • To preserve a congruence during the tilting movement in the frontal plane, and therefore an absence of bumps and mechanisms of severing or loosening;
    • - To communicate this device a good stability of the parts to each other during the movements from front to back and the lateral inclination;
    • - To preserve a surface of total medial-lateral contact from the extension to the full inflection, wherein the surface is continuously reduced by contacting the spiral curves.

Claims (5)

  1. Knee prosthesis of the type comprising a generally metallic femoral part ( 1 ) suitable for implantation in a femur (femur), a generally metallic tibial component ( 2 ), which is suitable for implantation in a tibia, and an insert ( 3 ) of a plastic material such as polyethylene, which is located between the tibial part ( 2 ) and the femoral part ( 1 ), the insert ( 3 ) fixed to the tibial part ( 2 ) or rotatable about a vertical axis relative thereto, and a femoral part ( 1 ) facing contact surface, wherein the contact surface of the insert ( 3 ) cut in a sagittal plane a concavity forms from the front of the insert ( 3 ), which corresponds to the front of the (SpiT) knee, to the back of the insert ( 3 ), which corresponds to the back of the knee, and cut in a frontal plane a curve (S2) having a projecting middle section (FIG. 9 ), which is a part of the femoral part ( 1 ) facing convexity, said projecting middle section ( 9 ) on each of its pages to a recessed section ( 8th ) to form a wavy curve, and where the femoral part ( 1 ) has a contact surface, on the one hand two side sections ( 7 ), which are suitable in the two lateral depressions ( 8th ) of the corresponding profile of the mission ( 3 ) And on the other hand a recessed middle section ( 10 ), between the side sections ( 7 ) and is adapted to be mounted on the projecting middle section ( 9 ) of the mission ( 3 ), Whereby the contact surface of the femoral part ( 1 ) in a sagittal plane forms a convexity from the front side to the rear side and cuts in a frontal plane a curve (S1) containing a section corresponding to the recessed central section (FIG. 10 ), this section corresponds to the use ( 3 ) facing concavity and connects on each of its sides to sections that the two side sections ( 7 ) correspond; characterized in that the curves (S1 and S2) in a frontal plane starting from the one side to the other side portion ( 7 ) from the front to the back of the femoral part ( 1 ) and the mission ( 3 ) describes a succession of the interlocking concave-convex, then convex-concave and concave-convex, and in that the contact surfaces of the femoral part ( 1 ) and the mission ( 3 ) have neither any discontinuity nor an edge nor an angle nor a flattening inside these surfaces, and cooperate by continuous contact of each of the two side sections ( 7 ) and the in-depth section ( 10 ) of the femoral part ( 1 ) with each of the corresponding sections of the mission ( 3 ) in the course of all their movements in each of the sagittal and frontal planes.
  2. Prosthesis according to claim 1, characterized in that the contact surface of the femoral part ( 1 ) from the front to the back of the femoral part ( 1 ) is formed starting from a spiral curve in the sagittal plane, which in the frontal plane passes through the curve (S1) which has the section which corresponds to the recessed middle section (FIG. 10 ), and the contact area of the insert ( 3 ) from the front to the back of the insert ( 3 ) is formed starting from a spiral curve in the sagittal plane, which in the frontal plane passes through the curve (S2), which has the section which corresponds to the projecting middle section (FIG. 9 ) corresponds.
  3. Prosthesis according to claim 1 or 2, characterized in that the convex middle section ( 9 ) of the mission ( 3 ) over a curve of constant radius (R ' 2 ) from front to back to the two lateral recessed sections ( 8th ) of the mission ( 3 ).
  4. Prosthesis according to one of the preceding claims, characterized in that the recessed middle section ( 10 ) of the femoral part ( 1 ) over a curve of constant radius (R 2 ) from front to back to the side sections ( 7 ).
  5. Prosthesis according to one of the preceding claims, characterized in that the projecting middle section ( 9 ) of the mission ( 3 ) and the recessed mid-section ( 10 ) of the femoral part ( 1 ) in the sagittal plane have two curves which cooperate in the manner of a cam and which are determined from radiographs of the joint movement of the knee, wherein the cam is such that the bearing center of the femoral part ( 1 ) on the insert ( 3 ) at a diffraction angle of 0 ° a few millimeters before the center of the insert ( 3 ) and that it is at a certain degree of diffraction, which is between 15 ° and 20 °, a few millimeters behind the center of the insert ( 3 ) recedes.
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PCT/FR2000/002133 WO2001006961A1 (en) 1999-07-26 2000-07-25 Novel knee prosthesis

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AT278368T (en) 2004-10-15
FR2796836B1 (en) 2002-03-22
EP1196118A1 (en) 2002-04-17
WO2001006961A1 (en) 2001-02-01
JP4312404B2 (en) 2009-08-12
DE60014650D1 (en) 2004-11-11
PT1196118E (en) 2005-02-28
JP2003505148A (en) 2003-02-12
DK1196118T3 (en) 2005-01-31
ES2231246T3 (en) 2005-05-16
AU7007700A (en) 2001-02-13
US6893467B1 (en) 2005-05-17
FR2796836A1 (en) 2001-02-02
EP1196118B1 (en) 2004-10-06

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